Full-Term Breech: Caesarian vs Vaginal Delivery

"You develop a relationship with that midwife, they understand you, and you develop a trust so that when you are in labour the person there is someone you have a relationship with."
Jamie Brignell McCallum, mother of two breech babies, one caesarian delivery

"Even though breech birth is within midwives' scope of practice, hospitals can decide to limit midwives' scope."
"This means that the types of births midwives are allowed to attend in hospital are limited, forcing clients to transfer care to an obstetrician, even though they have a midwife who has followed them through their pregnancy and is willing and able to care for them."
Mothers of Change of the National Capital Region

"[The Ottawa Hospital's board looks forward to the] presentation by the Mothers of Change of the National Capital Region." 
"Our hospital continues to work closely with our own midwives, the College of Midwives, and the midwife and patient community at large to support a patient's birth delivery of their choice."
The Ottawa Hospital, Ottawa, Ontario

Midwives operating in Ontario are routinely trained to delivery breech babies -- babies that present buttocks or feet first in the birth canal when preparing to emerge -- and are competent in their professional capacity to meet the needs of mothers whose babies are breech, not by caesarean section but vaginally, as a normal procedure treated with a little extra care and manipulation. In Canada, around 2000, vaginal breech delivery came to a virtual halt when research linked it to higher complication risks. Doctors faced with breech birth switched to caesarean section.

However, in 2009 new evidence persuaded the Society of Obstetricians and Gynecologists of Canada to reverse that trend and to recommend that physicians should no longer automatically decide that caesarean sections for breech births represented the option of first choice. Many women, urged the Society, can safely deliver breech babies vaginally. Caesarean sections in Canada had become so commonplace -- though it is serious surgery with greater chances of things going awry for mother and child in complications, as well as a longer recovery time -- they became a matter of concern.

Doctors however, with little exposure to the alternative and experience in the vaginal delivery of breech babies preferred to continue high rates of caesarean sections for women delivering breech babies, in spite of the official policy recommendations. Mothers and advocates for change have observed that midwives still face obstacles in hospital settings in practising the full extent of their skills, notably including vaginal birth deliveries for breech babies.

This situation has led to a protest against hospital requirements that only physicians be authorized to tend to breech births, leading to the necessity of midwives being forced to transfer the care of patients they have served throughout pregnancy to the physicians deployed at the hospital in the delivery of breech babies -- by caesarean section exclusively, a policy that is of great concern to area mothers along with their advocates.

Women complain they experience "a lot of pressure" to agree to having a caesarean section when their babies present in the breech position. Apart from the group Mothers of Change, The Coalition for Breech Birth advocates as well for "the return of vaginal birth to the normal options offered to women with breech babies". One out of every 25 full-term births turns out a breech delivery, so the issue is one of substantial measurement.

• Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
• Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
• Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.                                              americanpregnancy.org/labor-and-birth/breech-presentation/

 
Risks associated with a caesarean birth for women include:

• Nausea and vomiting after the surgery.
• Difficulty moving around easily after the surgery.
• Developing blood clots that could travel to your lungs or brain.
• Pain that lasts days to weeks after the birth.
• Re-opening of the surgical wound.
• Infection.
• Scarring of the uterus, which can cause complications in future pregnancies and births.
• Accidental cuts to your bladder or bowel.
• Complications from the anesthetic.
• Bleeding. If uncontrollable, in rare circumstances your uterus may need to be removed.
• Death (extremely rare with today’s advanced technology and care processes). ontariodirectoryprenataleducation.ca

"The thing that we have to keep in mind is that there will always be women who want a normal, natural childbirth."
"There's major fear around vaginal birth. And trying to undo it is really difficult when you've got an entire cohort of physicians who have not been trained to do it."
"And more have been trained to fear it."
Ottawa midwife Betty-Anne Daviss, practising for 30 years, attended 150 vaginal breech births

Leanne Moussa with Isa Russell Qureshi. delivered by Betty-Anne Daviss in complete breech at 42 weeks.